Provider Demographics
NPI:1649431552
Name:CMCP- MONTROSE, LLC
Entity type:Organization
Organization Name:CMCP- MONTROSE, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:RIJOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-977-3700
Mailing Address - Street 1:330 N WABASH AVE
Mailing Address - Street 2:SUITE 1400
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3586
Mailing Address - Country:US
Mailing Address - Phone:312-977-3700
Mailing Address - Fax:312-977-3701
Practice Address - Street 1:100 BROOKMONT RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-9207
Practice Address - Country:US
Practice Address - Phone:330-666-4545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKDALE SENIOR LIVING, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-06-23
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2370R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAPPLIED FOROtherMEDICAID WAIVER PROVIDER